According to an epidemiological study, hip joint involvement was detected in 12–56% of patients with axial spondyloarthritis (axSpA) in Russia. Data on the incidence of coxitis in patients with axial psoriatic arthritis (axPsA) are lacking. The aim of the study was to compare radiographic changes in the hip joints in patients with axial spondyloarthritis and axial psoriatic arthritis and to evaluate the relationship between coxitis and disease activity. Material and methods. The study included 222 patients with a mean age of 35.7±12.7 years. The first group included 108 patients who met the 2009 ASAS (Assessment of SpondyloArthritis International Society) criteria for axSpA or the 1984 criteria for ankylosing spondylitis (AS); The second group included 114 patients with axPsA who met the CASPAR (ClASsification for Psoriatic ARthritis) criteria. Signs of axial involvement in psoriatic arthritis (PsA) were determined using instrumental imaging methods. Diagnosis required the presence of radiologically reliable sacroiliitis (SI), i.e., bilateral stage ≥II or unilateral stage ≥III according to Kellgren, or active sacroiliitis according to magnetic resonance imaging. The presence of at least one syndesmophyte (paraspinal ossificate) in the cervical (CS) or lumbar (LS) spine, as well as ankylosis of the facet joints of the CS, were also taken into account. The mean age of disease onset was 26.3±20.3 years; HLA-B27 was detected in 54% of patients. The diagnosis of coxitis was established based on a pelvic X-ray and calculation of the Bath Ankylosing Spondylitis Radiology Hip Index (BASRI hip) for each joint. Results. Radiographic evidence of coxitis was detected in 52 of the 222 patients included in the study, including 22 patients with AS and 30 patients with axPsA. Patients with axPsA were older than those with axSpA (median age 32 years and 45 years, respectively; p<0.05). Radiographic coxitis was more common among men with axSpA and equally common among men and women with axPsA. The ASDAS (Axial Spondyloarthritis Disease Activity Score) index value was high in both groups; however, it was statistically significantly higher in patients with axPsA than in patients with axSpA (on average, 2.1 and 3.2, respectively; p<0.05). Acute phase indices (C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)) were slightly higher in axSpA than in axPsA (CRP – 5.8 and 4.2 mg/L; ESR – 20 and 17 mm/h, respectively), but these differences were not statistically significant (p>0.05). Functional impairment according to BASFI (Bath Ankylosing Spondylitis Functional Index) was more pronounced in axPsA than in patients with axSpA (p<0.05). Peripheral arthritis was also more common in patients with axPsA (96.6% and 59.0%, respectively; p<0.05). Conclusion. Radiographic coxitis was detected in 20% of patients with axSpA and 26% with axPsA. In previous studies, the incidence of radiographic coxitis in patients with psoriatic arthritis did not exceed 10%. According to our study, patients with axPsA had high clinical and laboratory indicators of disease activity, as well as significant functional impairment.

To evaluate the timeline for resolution of sacroiliac joint (SIJ) inflammation, changes in structural lesions, and their correlation with patient-reported outcomes in youth with axial juvenile spondyloarthritis (axJSpA) initiating TNF inhibitor (TNFi). This prospective, multicenter study included youth aged 8-18 with a clinical diagnosis of axJSpA starting TNFi. Assessments were conducted at baseline and 12 weeks, including clinical evaluation, MRI, and patient-reported outcomes. Participants with persistent SIJ inflammation at 12 weeks were reassessed at 24 weeks. Three blinded reviewers evaluated MRIs using SPARCC inflammation (SIS) and structural (SSS) scores. Of 75 enrolled participants, 73 completed baseline visits, and 62 had MRI-confirmed axJSpA. Fifty-seven completed a 12-week follow-up; 89% (51/57) showed SIS improvement, and 63% (36/57) achieved inflammation resolution (SIS <2). Median SIS change from baseline to 12 weeks was -8 (IQR: -18 to -3). Among those with persistent inflammation at 12 weeks (n=26), 85% reported at least moderate clinical improvement. At 24 weeks, 56% (14/25) had ongoing inflammation. 84% of SIS improvement occurred within the first 12 weeks. In patients with ≥2 scans, structural lesion scores decreased/increased/stayed the same from baseline to the 12-week scan for erosions (58%/25%/18%), sclerosis (21%/9%/70%), fat metaplasia (0%/30%/70%), and backfill (4%/28%/68%). Most participants showed early imaging response to TNFi, with most improvement occurring within 12 weeks. Despite residual inflammation persisting in nearly half of patients, most reported symptom improvement, underscoring both the rapid impact of TNFi and the heterogeneity of treatment effects.

Risankizumab, an anti–IL-23 monoclonal antibody, is approved for the treatment of peripheral psoriatic arthritis (PsA), and increasing evidence suggests its potential efficacy in patients with concurrent axial involvement. This study presents a preliminary monocentric real-world experience on the use of risankizumab in PsA, with clinical follow-up over six months of treatment. 34 patients with PsA treated with risankizumab at our center were included in this study. Of these, 18 had peripheral involvement only, while 16 presented both peripheral and axial involvement. Clinical assessments included DAPSA for peripheral disease, ASDAS-CRP and modified BASDAI (mBASDAI) for axial involvement. Patients were further stratified by treatment line (naïve to fourth-line) and therapy regimen (monotherapy vs. combination with methotrexate). The aim was to evaluate the evolution of clinical parameters over the course of treatment. Moreover, MRI was used to assess sacroiliac joint inflammation in patients with axial involvement. At baseline (T0), all patients underwent clinical evaluation using DAPSA, ASDAS-CRP, and mBASDAI scores, with regular follow-up assessments over six months (T6). Among the 16 patients with both peripheral and axial involvement, there was a marked improvement in ASDAS-CRP and mBASDAI scores, indicating a beneficial effect of risankizumab in reducing both axial and peripheral symptoms, as shown in the graphs. Regarding treatment lines, 8.8% of patients were treatment-naïve, while 58.8% received risankizumab as second-line, 20.6% as third-line, and 8.8% as fourth-line therapy. Risankizumab was administered in combination with methotrexate (MTX) in 70% of cases, and as monotherapy in 30%, demonstrating efficacy across both treatment regimens, including in patients with prior biologic exposure. As a representative case, MRI images from a 50-year-old female with axial PsA are included, showing marked improvement after six months of risankizumab. Our findings are consistent with current literature supporting the efficacy of risankizumab in peripheral PsA, while also offering new insights into its potential benefits for patients with concurrent axial involvement. This therapeutic effect may be attributed to the distinct pathophysiology of axial PsA (axPsA) compared to ankylosing spondylitis (AS). According to McGonagle et al., axPsA is primarily driven by ligament-centered inflammation, in contrast to the deep bone inflammation of AS. This anatomical and immunological distinction provides a mechanistic rationale for the observed clinical efficacy of IL-23 inhibitors in axPsA—despite their failure in AS—by targeting soft tissue immune responses more responsive to IL-23 modulation. Our center’s experience confirms the efficacy of risankizumab not only in peripheral PsA but also in patients with axial PsA (axPsA), showed in clinical and clinimetric indices improvement. These findings contribute valuable real-world data to the growing body of evidence supporting the therapeutic potential of risankizumab in PsA, including cases with axial involvement.

BackgroundCurrently, sacroiliac joint (SIJ) arthritis is the sole imaging criterion for confirming a diagnosis of ankylosing spondylitis (AS). However, numerous studies have demonstrated that SIJ inflammation lacks specificity. Notably, some patients with non-radiographic axial spondyloarthritis (nr-axSpA) cannot be diagnosed with AS due to an absence of imaging changes indicative of SIJ arthritis, resulting in delayed diagnosis and treatment. The costovertebral joints (CVJs), similar to the SIJ, are synovial joints located adjacent to the vertebral column. The potential of the CVJ to serve as an indicator for the early diagnosis of AS warrants further investigation. This study utilized a retrospective research design to investigate the potential diagnostic value of CVJ arthritis in AS.MethodsPatients diagnosed with nr-axSpA and AS at The Affiliated Hospital of Southwest Medical University between September 2018 and December 2023 were selected as the study cohort. Concurrently, healthy individuals undergoing routine medical examinations, matched for baseline characteristics, were recruited as the control group. The prevalence of CVJ arthritis among the different cohorts was assessed utilizing computed tomography (CT) and magnetic resonance imaging (MRI), with lesions being graded based on their severity. Furthermore, to the association between CVJ involvement and the formation of periosteal new bone (PNB) on the adjacent vertebral body’s upper endplate was explored. Additionally, the link between CVJ arthritis and SIJ arthritis in the same patients was studied.ResultsCVJ arthritis occurred in 29.2% of patients diagnosed with nr-axSpA, indicating a notably higher rate compared with the control group. CVJ arthritis occurred in 96.2% of patients with AS, which was significantly higher than that in the control group (7.2%, χ2=84.436, P<0.001). PNB was most likely to be distributed in the posterolateral part of the vertebral body adjacent to the CVJ. The severity of CVJ arthritis was positively associated with the incidence of PNB formation and moderately correlated with SIJ arthritis in the same patients.ConclusionsCVJ arthritis was found in 29.2% of patients with nr-axSpA. Moreover, the severity of CVJ arthritis was positively associated with the incidence of PNB formation and moderately correlated with SIJ arthritis in the same patients. This finding suggests that CVJ arthritis could potentially serve as a novel biomarker for the diagnosis of AS.

Imaging evidence of active sacroiliitis is important for diagnosis, classification, and monitoring of axial spondyloarthritis (axSpA). However, there is no consistent guidance on whether patients should temporarily stop nonsteroidal anti-inflammatory drugs (NSAIDs) before magnetic resonance imaging (MRI). The aim of this study was to determine whether NSAIDs lead to an underestimation of active sacroiliitis, as observed using MRI. Adults with axSpA were recruited from rheumatology clinics and undertook NSAID washout for one to two weeks before a sacroiliac joint MRI scan. Images were read by two independent readers and adjudicated by a third if required. Those who had a positive result for active sacroiliitis, as per internationally recognized criteria, underwent a second scan six weeks after recommencing daily NSAIDs. We determined the proportion of participants who had a negative scanning result while taking NSAIDs after a previous positive result when NSAID-free. Images were also scored using semiquantitative methods comprising lesion size and intensity, and a subset of participants underwent quantitative MRI (qMRI) to provide an objective evaluation of any inflammatory changes. From 34 centers across the United Kingdom, 311 participants (median age 42 years; 62% male) were recruited; 286 (92%) completed the NSAID washout and underwent the first MRI scan. From 146 participants with active sacroiliitis, follow-up scans (while taking NSAIDs) were obtained from 124 (85%), at which point 25 participants had a negative result (20.2%; 95% confidence interval 13.5%-28.3%). Semiquantitative and qMRI methods supported these findings. One-fifth of patients showed full resolution of active sacroiliitis lesions when NSAIDs were present. In clinical practice, if patients with axSpA are willing to attempt a one- to two-week NSAID washout before MRI, this should be considered.

Ankylosing spondylitis (AS), characterized by inflammation of sacroiliac joints and spinal attachments, has an unclear pathogenesis. This study aims to screen and authenticate immune cell-associated biomarkers in AS. Two Gene Expression Omnibus datasets (GSE25101 and GSE41038) were combined as the discovery dataset, with candidate biomarkers screened via differential expression analysis, immune cell infiltration analysis, and weighted gene co-expression network analysis (WGCNA). Immune cell-related biomarkers were further identified and validated by receiver operating characteristic (ROC) analysis using the confirmatory dataset GSE73754, and potential diagnostic biomarkers were finally confirmed by reverse transcription quantitative polymerase chain reaction (RT-qPCR), immunofluorescence staining, and single-cell RNA sequencing (scRNA-seq) analysis (GSE194315). Thirty-two differentially expressed genes between the AS and control samples were identified. The ratio of M2 macrophages was significantly different between the AS and control samples. Seven candidate biomarkers associated with immune cells in AS were identified by WGCNA and Venn diagram. Then, three genes (SBK1, HNRPR, and CX3CR1) were authenticated as immune cell-associated biomarkers in AS by ROC curves, indicating a possible diagnostic value in clinical settings. The results of RT-qPCR, immunofluorescence staining, and scRNA-seq analysis all confirmed that CX3CR1 was down-regulated in AS, which was in line with bioinformatics study findings. Dysregulation of the CX3CR1 and M2-type macrophage ratio are key factors in AS, which lay the groundwork for exploring illness pathophysiology and yielding fresh perspectives on AS diagnosis and therapy.

Inflammation of the sacroiliac joints (SIJ) – sacroiliitis (SI) – is an obligatory criterion of axial spondyloarthritis. The main place in the diagnosis of SI is occupied by X-rays and magnetic resonance imaging (MRI). Anatomical features of the SIJ structure can mimic the signs of radiologic and active SI according to MRI, which often leads to diagnostic errors. The article discusses the variability of anatomical changes of the SIJ and its correlation with imaging findings.

ObjectivesThe musculoskeletal (MSK) system is the most frequent extraintestinal manifestation (EIM) in Crohn’s disease (CD).[1] One pediatric study has reported on asymptomatic sacroiliitis (SI) in pediatric inflammatory bowel disease (pIBD), detecting this in 15% (5/34).[2] MSK EIMs can have a serious impact on patients’ quality of life and are associated with increased severity of bowel disease activity in pIBD.[3] Given the paucity of literature on this topic, we aim to describe the prevalence of asymptomatic SI and its relationship to clinical characteristics, bowel disease phenotype, intestinal disease activity scores, biomarkers, and other EIMs of disease.MethodsIn this single-center, retrospective cohort study, data were collected from newly diagnosed (&lt;1 year) pediatric CD patients who had undergone magnetic resonance enterography (MRE) at Children’s Hospital, London Health Sciences Centre over 4 years (2019-2023). Subjects were excluded if the sacroiliac joints were unable to be adequately assessed by the radiologist or if the patient had a previously known diagnosis of spondyloarthritis. Coronal T1, axial T2, and coronal T2W sequences with fat suppression of the MREs were evaluated by an MSK-trained radiologist, with a secondary read by a pediatric-trained MSK radiologist (25% of the cases) to establish inter-rater reliability. Descriptive statistics were used to describe baseline characteristics and group comparisons.ResultsAmong 135 patients with CD who underwent MRE, 10 patients (7.4%) showed evidence of SI on MRE. Patients were sub-categorized as acute SI (2.2%), chronic SI (3%), and acute on chronic SI (2.2%) (Table 1). Half of the patients with evidence of SI on MRE had evidence of inflammatory MSK manifestations. Patients with SI had higher frequency of arthralgia (p-value 0.033), joint swelling (p-value 0.039), and enthesitis (p-value 0.019). There were no significant differences in symptoms of back pain, neither mechanical nor inflammatory. Patients with SI did have significantly higher Simple Endoscopic Scores-CD at initial scope assessment compared to those without (p-value 0.006).Table 1:Clinical characteristics of pediatric Crohn’s disease patients with magnetic resonance enterography imaging.ConclusionAmong newly diagnosed pediatric CD patients who underwent MRE examination, 7.4% were identified to have SI. Patients with CD and SI were more likely to report other MSK symptoms and had higher CD endoscopic scores. Limitations of this study include the lack of systematic rheumatology assessment of CD patients for MSK signs/symptoms. Further analyses are planned to evaluate the bowel disease outcomes in patients with SI over time. [1.] Ali A. ACR Open Rheumatol 2022;4(6):547-54. [2.] Giani T. Pediatr Rheumatol 2020;18(1):1-6. [3.] Derfalvi B. Pediatr Rheumatol 2022;20(1):1-9.

ObjectiveThe objective of this study was to determine a core set of measures for youth with juvenile spondyloarthritis and axial disease (axJSpA), using the juvenile arthritis working group Outcome Measures in Rheumatology framework.MethodsThis was a prospective multicenter study of youth with axJSpA. Participants (aged 8–18 years) all initiated tumor necrosis factor inhibitor (TNFi) therapy and completed questionnaires, examinations, and magnetic resonance imaging (MRI) at baseline and 12 weeks. Responsiveness and discrimination were assessed using standardized response mean (SRM) and standardized mean difference (SMD). For highly correlated (r > |0.80|) items within domains, larger SRM and SMD were prioritized, and minimal clinically important improvement was determined for each.ResultsOf the evaluable cohort (N = 57), 68.4% were male, and the median age was 15.3 years; 70.2% of youth treated with TNFi had clinical response (change ≥2 in patient global assessment). Although 58% had continued MRI inflammation, 77% of those patients reported moderate clinical improvement. The final axJSpA core set contained the following: Patient‐Reported Outcomes Measurement Information System (PROMIS) pain interference (SRM 0.77, SMD 0.5), the sacroiliac joint inflammation score (SRM 1.02, SMD 0.52), PROMIS mobility (SRM 0.83, SMD 0.75), and patient global well‐being (SRM 0.88, SMD not applicable). All overall and composite disease activity measures tested, except the physician global assessment, had high SRM and SMD. Subgroup analysis demonstrated differences by biologic sex and overweight status. Improvement in the MRI inflammation score was greater in male patients. Improvement in the PROMIS pain interference and mobility measures was greater in those with normal body mass index.ConclusionA set of measures was developed for youth with axJSpA.

Background: Juvenile spondyloarthritis (JSpA) is a heterogeneous group of diseases. An international consensus group developed the axial juvenile SpA (AxJSpA) classification criteria for this purpose, defining a homogeneous group of patients diagnosed with jSpA and experiencing axial symptoms before the age of 18 years. Aim: To validate this new set of criteria in our pediatric SpA patients. Methods: This study was held in the Hacettepe University Department of Pediatric Rheumatology. Juvenile SpA patients suspected of axial disease diagnosed and followed at the same center between 2005 and 2024 were included. Patients who had other etiologies for axial symptoms, including chronic nonbacterial osteomyelitis, mechanical back pain-overuse injuries, amplified pain/growing pains, and SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, and osteitis) served as the control group. Results: In total, 123 JSpA patients and 74 controls were included in this study. The sensitivity/specificity of the new criteria were 61%/77% with an area under curve value of 0.75 (95% CI: 0.68-0.83) in our cohort. Among different criteria sets, European Spondyloarthropathy Study Group (ESSG) criteria were the most sensitive (sensitivity/specificity 91%/68%), and ASAS peripheral criteria (Assessment of SpondyloArthritis International Society) were the most specific (sensitivity/specificity 67%/84%) in our cohort when compared to ASAS axial criteria (sensitivity/specificity 74%/65%), ILAR (International League of Associations for Rheumatology) (sensitivity/specificity 85%/81%), and ILAR + SI (sacroiliitis) (sensitivity/specificity 67%/74%) criteria. Conclusions: The area under the curve of the new AxJSpA criteria was similar to that of the original report; however, both sensitivity and specificity were lower in our cohort, possibly due to factors like earlier disease presentation and a lower prevalence of chronic structural changes on MRI.

Abstract Background/Aims Chronic inflammatory bowel disease (IBD) can have extra-intestinal manifestations, notably osteoarticular manifestations such as sacroiliitis (SI). It may be symptomatic, inaugurating associated spondyloarthritis, or asymptomatic, consistent with isolated SI. The aim of this study is to investigate the prevalence and clinical and radiographic characteristics of SI in IBD. Methods This was a retrospective study of patients treated for Crohn’s disease (CD) or ulcerative colitis (UC). Radiographic study of the sacroiliac joints was carried out via the patient’s computerized medical record. Statistical study was carried out using SPSS version 25 software. The significance level was p &amp;lt; 0.05. Results Sixty patients (48 men and 12 women) with a mean age of 44 ±15 years were included. The mean age at IBD diagnosis was 35 ± 14 years. These were respectively CD (60%) and UC (40%). Standard radiography, performed in 34 patients, was pathological in 38.2% (13/34). According to Forrestier, it was classified as follows: stage 1 (11.8%), stage 2 (8.8%), stage 3 (5.9%) and stage 4 (11.8%) of cases. SI was suspected by entero-scanner in 10% of cases. UC patients accounted for 37.5% (n = 6) and CD patients for 62.5% (n = 10). The CD was ileocolic in 80% and of stenosing phenotype in 60% of cases. Six patients with IBD and SI were on biotherapy. Sacroiliac joints involvement was asymptomatic in 43.75% of cases. Nine patients (56.25%) were diagnosed with IBD-associated spondyloarthritis. The analysis shows that patients with SI were more often treated with biotherapy monotherapy than with combotherapy (p = 0.02). Furthermore, no association was noted between the presence of radiographic SI and these parameters: gender, IBD phenotype, extent and character of disease. Conclusion Asymptomatic SI is common in patients with IBD. Once revealed, regular follow-up of these patients is necessary to detect any associated spondyloarthritis at an early stage. Disclosure C. Ben Ammar: None. H. Bettaieb: None. M. Boudokhane: None. R. Bourguiba: None. E. Chemkhi: None. M. Ayari: None. T. Jomni: None. M. Douggui: None. S. Bellakhal: None.

Abstract Background/Aims The impact of dual inhibition of interleukin (IL)17F in addition to IL-17A with bimekizumab (BKZ) on structural lesions in axial spondyloarthritis (axSpA) patients has not yet been shown. We report BKZ impact on MRI inflammatory and structural lesions in sacroiliac joints (SIJ) of non-radiographic and radiographic (nr-/r-)axSpA patients to week (wk) 52 in the phase 3 studies BE MOBILE 1/2 (NCT03928704/NCT03928743). Methods In BE MOBILE 1/2 (nr-axSpA/r-axSpA), patients were randomised to BKZ 160mg every 4 wks or placebo (PBO); all patients received BKZ from Wk16-52. Spondyloarthritis Research Consortium of Canada (SPARCC) SIJ inflammation score and SPARCC SIJ Structural Scores (SSS: erosion/backfill/fat lesions/ankylosis) were assessed at baseline, wk 16 and wk 52 in MRI sub-studies. MRIs were assessed centrally by two independent experts (disagreement adjudicated). Inflammatory and structural lesions were assessed by different readers. All readers were blinded to timepoint/clinical data; structural lesions were analysed post hoc. For patients with valid MRI assessments at all three timepoints, we report patient proportions with baseline inflammation scores ≥2 achieving MRI remission (score &amp;lt;2), mean absolute inflammation scores and wk 16/52 change from baseline in SPARCC SSS (observed case). Results 60% (152/254) and 42% (139/332) of nr- and r-axSpA patients were enrolled in MRI sub-studies; at all three timepoints, 76% (115/152) and 78% (109/139) had valid SPARCC SIJ inflammation assessments, respectively, and 84% (128/152) and 83% (116/139) had valid SPARCC SSS assessments. Among those with valid SPARCC SIJ inflammation assessments at all three timepoints and baseline inflammation scores ≥2 (nr-axSpA: PBO: 32, BKZ: 39; ra-xSpA: PBO: 18, BKZ: 36), a larger proportion of BKZ- vs PBO-randomised patients achieved MRI remission at wk 16 (nr-axSpA: PBO: 9/32 [28.1%], BKZ: 26/39 [66.7]; r-axSpA: PBO: 3/18 [16.7%], BKZ: 21/36 [58.3%]). Proportions of continuous BKZ patients and patients switching from PBO to BKZ at wk 16 (PBO-switchers) achieving MRI remission increased from wk 16-wk 52 (nr-axSpA: PBO-switchers: 18/32 [56.3%], continuous BKZ: 31/39 [79.5%]; r-axSpA: PBO-switchers: 12/18 [66.7%], 27/36 [75.0%]). Substantial reductions in wk 16 mean absolute SPARCC SIJ inflammation scores (nr-axSpA: 1.6; r-axSpA: 1.2) were maintained to wk 52 for continuous BKZ patients (nr-axSpA: 1.0; Wk52 r-axSpA: 0.9); PBO-switchers reached similar levels of improvement as the BKZ-continuous group at wk 52 (nr-axSpA: 1.8; r-axSpA: 0.9). Reductions in SSS for erosions and increases in backfill and fat lesions were observed with BKZ vs PBO at wk 16, with further improvements mostly observed to wk 52 in continuous BKZ patients; similar changes were observed in PBO-switchers. No or minimal changes in SSS for ankylosis were observed following BKZ treatment in nr- and r-axSpA patients, respectively, to wk 52. Conclusion BKZ had a substantial impact on SIJ MRI inflammation and structural lesions, indicating potential tissue repair after only 16 wks of treatment. This continued to improve from wk 16 to wk 52. Disclosure W.P. Maksymowych: Honoraria; Honoraria/consulting fees from AbbVie, BMS, Boehringer Ingelheim, Celgene, Eli Lilly, Galapagos, Johnson &amp; Johnson Innovative Medicine, Novartis, Pfizer and UCB. Grants/research support; Research grants from AbbVie, Galapagos, Pfizer and UCB; educational grants from AbbVie, Johnson &amp; Johnson Innovative Medicine, Novartis and Pfizer. Other; Chief Medical Officer for CARE ARTHRITIS. S. Ramiro: Consultancies; Consulting fees from AbbVie, Eli Lilly, Galapagos, Johnson &amp; Johnson Innovative Medicine, Novartis, Pfizer, Sanofi and UCB. Grants/research support; Grants from AbbVie, Galapagos, MSD, Novartis, Pfizer and UCB. D. Poddubnyy: Consultancies; Consultant for AbbVie, Biocad, Eli Lilly, Gilead, GSK, MSD, MoonLake, Novartis, Pfizer, Samsung Bioepis and UCB. Member of speakers’ bureau; Speaker for AbbVie, BMS, Eli Lilly, MSD, Novartis, Pfizer and UCB. Grants/research support; Grant/research support from AbbVie, Eli Lilly, MSD, Novartis and Pfizer. X. Baraliakos: Consultancies; Consultant for AbbVie, BMS, Chugai, Eli Lilly, Galapagos, Gilead, Novartis, Pfizer and UCB. Member of speakers’ bureau; Speakers bureau from AbbVie, BMS, Chugai, Eli Lilly, Galapagos, MSD, Novartis, Pfizer and UCB. Grants/research support; Grant/research support from Novartis and UCB. Other; Paid instructor for AbbVie, BMS, Chugai, Eli Lilly, Galapagos, MSD, Novartis, Pfizer and UCB. R.G. Lambert: Consultancies; Consultant for CARE Arthritis and Image Analysis Group. U. Massow: Corporate appointments; Employee of UCB. T. Vaux: Corporate appointments; Employee and shareholder of UCB. C. Prajapati: Corporate appointments; Contractor for UCB and employee of Veramed. A. Marten: Corporate appointments; Employee of UCB. N. de Peyrecave: Corporate appointments; Employee of UCB. M. Østergaard: Consultancies; Consulting fees from Abbott, Pfizer, Merck, Roche and UCB. Member of speakers’ bureau; Speakers bureau for Abbott, BMS, Merck, Mundipharma, Pfizer and UCB. Grants/research support; Research grants from Abbott, Pfizer and Centocor.

To present the clinical and imaging characteristics of patients with axial psoriatic arthritis (PsA) and to identify possible subtypes. Data were retrieved from the Greek-multicentre PsA study. Axial PsA (axPsA) was defined as PsA (CASPAR criteria) accompanied by inflammatory back pain (present or ever) and positive imaging findings of the sacroiliac joints and/or spine (MRI: active inflammation of sacroiliac joints and/or spine; X-rays: 1984 New York criteria for radiographic sacroiliitis and/or presence of syndesmophytes in the spine). Demographic and clinical characteristics were compared between axPsA and non-axPsA subsets. Two additional analyses were conducted: (i) isolated sacroiliac joint involvement (sacroiliac axPsA) vs isolated involvement of the rest of the spine (spinal axPsA); (ii) non-radiographic axPsA (nr-axPsA, positive MRI findings only) vs radiographic axPsA (r-axPsA, positive X-ray findings). Among 922 patients with PsA, 238 (25.8%) had axPsA. Patients with axPsA had less frequently peripheral arthritis at diagnosis, whereas they had increased rates of HLA-B27 positivity, enthesitis ever and inflammatory bowel disease. Among patients with axPsA, 42% (n = 101) had isolated sacroiliac axPsA and 32% (n = 75) had isolated spinal axPsA. Sacroiliac axPsA was associated with younger age (OR: 0.97, 95% CI: 0.94-0.99) and enthesitis at diagnosis (OR: 3.37, 95% CI: 1.66-6.82). A total of 35% of patients with axPsA had nr-axPsA and were more commonly females (OR: 2.59, 95% CI: 1.39-4.82) and younger (OR: 0.96, 95% CI: 0.94-0.99) compared with those with r-axPsA. Approximately one-quarter of patients with PsA exhibit axial involvement, and among them, ∼30% have isolated spinal axPsA and nr-axPsA, respectively.

Magnetic resonance imaging (MRI), utilizing fat-saturated T2-weighted and short-tau inversion recovery sequences, is essential for the early diagnosis and monitoring of axial spondyloarthritis (axSpA). Recently, the European Society of Musculoskeletal Radiology proposed recommendations for the standardization of MRI findings for axSpA. However, the predictive value of specific MRI findings for spinal ankylosis progression remains unclear. This study investigates whether baseline MRI findings correlate with the progression of spinal ankylosis observed on radiographs over a 2-year period. Twenty-six axSpA patients who met Assessment of SpondyloArthritis International Society criteria and underwent baseline and 2-year follow-up imaging were included. MRI assessments of the lumbar spine and sacroiliac joint evaluated inflammatory and structural lesions, including Romanus and Anderson lesions. Radiographic progression was defined as a ≥2-point increase in the modified Stoke Ankylosing Spondylitis Spinal Score. Statistical analyses compared clinical and imaging parameters between progression (n = 9) and nonprogression (n = 17) groups. Patients in the progression group had significantly higher baseline modified Stoke Ankylosing Spondylitis Spinal Score (P = .04) and modified-health assessment questionnaire scores (P = .04). Positive MRI findings of anterior and posterior corner inflammatory lesions and Anderson-central lesions were significantly associated with progression (P < .05). Romanus lesions, indicative of early structural changes, were more frequent in the progression group (P = .02). However, fat lesions and sacroiliac joint inflammation showed no significant predictive value. Baseline MRI findings, particularly inflammatory and Romanus lesions, are strong predictors of spinal ankylosis progression in axSpA. These results highlight the importance of incorporating MRI into personalized treatment strategies to mitigate disease progression. Further studies are needed to validate these findings in larger cohorts.

Early treatment initiation is one of the strongest predictors of good treatment response in axial spondyloarthritis (axSpA). Recently, the Assessment in SpondyloArthritis International Society (ASAS) defined early axSpA as a diagnosis of axSpA with a duration of axial symptoms equal to or less than 2 years. Tofacitinib is a Janus kinase (JAK) inhibitor for the treatment of ankylosing spondylitis. Compare the efficacy and safety of tofacitinib versus placebo (both on non-steroidal anti-inflammatory drug (NSAID) background) in patients with active early axSpA and inadequate response to at least one NSAID. This is a phase IV, randomized, double-blind, placebo-controlled, multicenter clinical trial. The study will recruit 104 patients aged ⩾18 and ⩽45 years with active early axSpA (chronic back pain ⩽2 years), inadequate response to at least one NSAID, and objective signs of active inflammation (on magnetic resonance imaging (MRI) of sacroiliac joints (SIJs) or elevated C-reactive protein). Patients will be randomized 1:1 to receive tofacitinib 5 mg twice daily or placebo, with background naproxen 500 mg twice daily for 16 weeks. Patients not meeting early treatment response criteria at week 4 will receive open-label tofacitinib until week 16. Primary and key secondary endpoints at week 16 will be the proportion of patients achieving disease remission (Axial Spondyloarthritis Disease Activity Score <1.3) and change from baseline in MRI SIJ Spondyloarthritis Research Consortium of Canada osteitis score, respectively. Safety will be monitored up to 4 weeks after the last study drug dose. The study will be performed according to the ethical principles of the Declaration of Helsinki and will be approved by independent ethics committees of each center. This is one of the first randomized clinical trials designed to evaluate the efficacy and safety of a JAK inhibitor in the recently ASAS-defined "early" axSpA population. Trial registration: ClinicalTrials.gov: NCT06112665; CTIS: 2023-505050-18-00.

BackgroundCurrently, the pathophysiology of new bone formation in radiographic axial spondyloarthritis (r-axSpA) remains unclear. Cellular elements and their secreted bone turnover markers might be one of the underlying mechanisms that drive the new bone formation. Our study aimed to investigate the role of bone turnover markers in r-axSpA patients with fatty lesions.Methods73 r-axSpA patients were enrolled in this study. 48 and 25 patients were divided into r-axSpA group with and without fatty lesions. Clinical variables were collected and all patients received comprehensive rheumatologic assessment for disease activity, including Modified Stoke Ankylosing Spondylitis Spine Score (mSASSS), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Axial Spondyloarthritis Disease Activity Score (ASDAS). Fatty lesions in the sacroiliac joints (SIJs) were scored independently by two radiologists. Serum levels of bone turnover markers, including sclerostin, osteoprotegerin (OPG), procollagen I N-terminal propeptide (PINP), cross linked C-telopeptide of type I collagen (CTX-I), osteocalcin (OC), were measured using enzyme-linked immunosorbent assays.ResultsThere were no significant differences between two groups in terms of gender, age, body mass index (BMI), duration, smoking, HLA-B27 positivity rate, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), BASDAI, ASDAS-ESR, ASDAS-CRP, biological disease-modifying anti-rheumatic drugs (bDMARDs) rate. No significant differences were observed in terms of OPG, PINP, CTX-I or OC between two groups. The mSASSS were higher in fatty lesions group than in those without fatty lesions (p < 0.001). The serum sclerostin levels were significantly lower in r-axSpA patients with fatty lesions than in those without fatty lesions (p < 0.001). There were correlations between BMI, mSASSS and sclerostin with the comprehensive Berlin scoring method (CBM) scores in the univariate analysis (ρ = 0.311, ρ = 0.306, ρ = -0.920, respectively). However, only sclerostin had correlation with the CBM scores in multivariate analysis (ρ = -0.040, p < 0.001).ConclusionsIn the r-axSpA patients with fatty lesions, serum sclerostin levels are declined. Serum sclerostin might be useful as a biomarker to predict the progression of the chronic inflammation in SIJs in r-axSpA.

Magnetic resonance enterography (MRE) is recommended for the assessment of small intestine alterations in Crohn’s disease (CD). Sacroiliac joints (SIJs) imaging has a central role in the early diagnosis of sacroiliitis (SI). MRE can evaluate both acute and structural findings of SIJs. We aimed to assess the prevalence of SI detected by MRE in a cohort of CD patients, and the associations of SI with demographic and clinical features and with intestinal MRE findings. Two hundred patients affected by CD (M:F 1:1, median age 49.5 (22.5) years, median CD duration 4.75 (16.2) years) tested with MRE between 2011 and 2023 were selected. They discontinued tumor necrosis factor α inhibitors (TNFαi) at least 3 months before the MRE execution. Most patients had an ileal CD location (65.0%) and a stricturing behavior of disease (50.0%). Thirty-five percent of patients underwent ileocecal resection. One out of ten patients were treated with at least one TNFαi. Active SI, capsulitis, erosions, sclerosis, and ankylosis were present in 10.5%, 0.5%, 2.0%, 2.5%, and 1.5%, respectively. No significant correlations have been evidenced between the presence of SI and demographic and clinical variables. The presence of an asymmetric hyperenhancement of the bowel wall was instead directly associated with the presence of SI (OR 8.61, 95% CI 1.47–50.4, p = 0.017). In this study, subclinical SI is a frequent finding in CD patients being present in one out of ten MRE examination. This phenomenon was significantly associated with asymmetric mural enhancement, a specific CD intestinal lesion at MRE.

Background: Axial spondyloarthritis (axSpA) is a chronic autoimmune and autoinflammatory disease characterized by low back pain and morning back stiffness with 18% to 25% of hip involvement. Magnetic resonance image (MRI) could detect active inflammatory changes in early-stage axSpA, such as BME, synovitis, joint effusion and enthesitis and help in differential diagnosis. Methods: This case report describes a young male with axSpA complicated with hip involvement. Further investigation by ultrasound and imaging facilitated in disease evaluation and differential diagnosis. Results: This 40-year-old male was an IT engineer, 168cm/65kg, presented with hip pain and low back pain. Physical examination showed no significant restriction on the movement of the right hip joint. Past medical history included lung tuberculosis (TB) in Jun 2024 with 6 months regular anti-TB treatment. Laboratory results showed that ESR was 16-23mm/h (0-15mm/h) and HLA-B27 ([Formula: see text]). Ultrasound identified right hip liquid dark zone (10.8*2.1mm). MRI showed abnormal signal around the right hip joint, suspecting rise body synovitis and possibly pigmented villonodular synovitis (PVNS) as well as right sacroiliac joint (SIJ) inflammation. The patient was diagnosed with axSpA according to the 2009 criteria, fulfilling the sacroiliitis on MRI imaging and positive serology of HLA-b27 as the SpA feature. He achieved partially improvement with NSAIDs. Sulfasalazine (SSZ) was added and induced liver injury. And unfortunately, he was allergic when exposed to thalidomide. He then initiated biologics after screening and consent. Unsatisfactory response to secukinumab was described and treatment was switched to ixekizumab since July 2025. The MDT discussion reached consensus for axSpA diagnosis with comorbid rice body synovitis and excluded the possibility of mimics (eg. PVNS) and axSpA hip involvement. Concerning the risk of TB reactivation, subsequent treatment would be tapering and discontinuation of biologics in case of disease remission status. On-demand NSAIDs and Intraarticular injection of steroids in the hip joint can be considered. And surgery would be helpful in illustration of pathological reason and pain relief if hip symptom aggravates. Conclusion: Rice body synovitis can be a concurrent situation in axSpA with hip involvement. Interleukin 17 inhibitor is safer option in patients with high risk for tuberculosis.

Background: Deep learning models based on the Spondyloarthritis Research Consortium of Canada (SPARCC) scoring system have been used in previous studies to assess sacroiliac joint inflammation in patients with axial spondyloarthritis (SpA). However, these patients also commonly have active spinal inflammation, and detecting these changes holds diagnostic, prognostic, and therapeutic significance. This study aimed to develop a deep learning algorithm for spinal inflammation based on SPARCC scoring system in patients with axial SpA. Methods: The study cohort included 330 participants with axial SpA. All patients underwent whole spine magnetic resonance imaging (MRI) with short tau inversion recovery (STIR) sequence by 3T MR unit. Three independent readers identified regions of interest (ROIs) to identify bone marrow edema (BME) and performed SPARCC scoring. Two deep learning models based on attention Unet were trained. The BME model was employed to differentiate image with or without spinal inflammation and to delineate BMEs. The vertebral body-intervertebral disc model was utilized to identify discovertebral units. Setting the threshold brightness was applied to detect the region with CSF. The intraclass correlation coefficient (ICC) and Pearson coefficient were used to evaluate the agreement and the correlation between the score of human readers and the score of deep learning-based pipeline. Performance of the models was evaluated using sensitivity, specificity, accuracy, and the Dice coefficient. Results: The ICC and the Pearson coefficient between the SPARCC scores from three human readers and the deep learning-based scoring pipeline were 0.80 and 0.82, respectively. The sensitivity and specificity of identifying image with spinal inflammation were 0.90 and 0.84, respectively. The accuracy of identifying the region containing CSF was 0.88 in images with spinal inflammation. The Dice coefficients were 0.81 (vertebral bodies) and 0.80 (intervertebral disc) in images with spinal inflammation. Conclusion: The high consistency with human readers suggested that the deep learning-based pipeline could offer a SPARCC-informed approach for scoring spinal STIR images in axial SpA.

BackgroundThe Assessment of SpondyloArthritis international Society Health Index (ASAS HI) is a novel questionnaire of global functioning for patients with axial spondyloarthritis (SpA).ObjectiveThe objective was to assess the construct validity,...